Debate heats up over novel tobacco and nicotine products’ harmfulness

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Italian MEP Alessandra Moretti has said scientists “know for sure” that novel alternative tobacco and nicotine products are harmful. However, some still question whether applying this approach of ‘precautionary principle’ is good for heavy smokers who cannot quit.

EU lawmaker Moretti (Partito Democratico – S&D) strongly defended the EU’s application of the precautionary principle, arguing that it should prevail in any public policy decision.

The principle implies that a policy should be dropped if it may cause harm, and its safety cannot be supported by sufficient scientific evidence; in essence, treating novel tobacco and nicotine products as harmful until proven otherwise.

“If we do not know the long-term effects with certainty, we cannot establish that they are harmless,” she told EURACTIV Italy.

“To date, we know for sure that they are harmful tools. The medium to long-term effects we will have in the short term, and unfortunately, I fear we will have scientific evidence confirming their harmfulness to health,” Moretti warned.

Novel products, such as heated tobacco, electronic cigarettes, nicotine pouches or snus, have emerged as an alternative to traditional smoking, which causes 700,000 deaths in Europe annually.

Backers of such products say they are much less harmful compared to traditional cigarettes while opponents say that they are still harmful and that, above all, we don’t know their long-term effects given they only recently entered the market.

Several member states, such as France and Germany, have recently come forward to prevent – from a tax or product regulation perspective – the proliferation of these products.

Moretti explained that the many chemicals that are inhaled through these instruments “penetrate into all organs”.

“For example, recent studies have found a probable correlation with bladder cancer,” she added.

Moretti also stressed the effects of nicotine, such as strong addiction, increased risks for the papillomavirus, hypertension, and cardiovascular diseases.

“We know that many of these instruments use more nicotine than a traditional cigarette. Therefore, it would be good if a product was only marketed when safe, both in the short and long term.”

Similarly, Cornel Radu-Loghin, a public health advocate for the European Network for Smoking and Tobacco Prevention (ENSP), told EURACTIV that no one can guarantee that these new products are less harmful.

“We may see the effects in 5, 10, or 20 years and these will be more harmful, who knows?” he noted.

Referring to heavy smokers who cannot quit, Radu-Loghin said a public health organisation would never recommend these products as a substitute but explained that any medical professional can assist the smokers to quit “in the way they consider is the best for the smoker”.

WHO, EU had the wrong target

Dr Konstantinos Farsalinos, a research fellow at Onassis Cardiac Surgery in Greece, offered a different view, saying that both the EU and the World Health Organisation (WHO) mistakenly target nicotine as the main culprit, rather than smoking itself.

“Nicotine has been demonised for decades because the only way to get nicotine was smoking […] while we now know that nicotine has relatively negligible contribution to the harm caused by smoking,” he explained.

Farsalinos said the EU’s cautiousness discourages smokers from using the new products and ultimately giving up smoking.

“It gives them a false impression that they are all the same and this is false information,” Farsalinos said, adding that both the EU and WHO have adopted a “cherry-picking” approach when it comes to scientific studies over the matter.

Asked how the tobacco industry could convince anyone with these arguments, considering that in the past, it claimed that light cigarettes were less harmful than normal ones, he replied: “Obviously you won’t believe the tobacco industry”.

“These are not products invented by the tobacco industry […] when the products appeared in the market initially, the industry was making fun of them and then they all stepped in,” he said.

For its part, the European Commission says any scientific evaluations concerning novel and emerging nicotine and tobacco products will be carefully considered.

“As minimum requirements, these should follow the relevant WHO recommendations, such as only relying on independent data sources or analysing risks of dual use with conventional tobacco products,” an EU official told EURACTIV.

“WHO highlights challenges regarding the scientific assessment of these products (e.g. wide variation of emissions, devices-content interactions, and specific features resulting in different levels of nicotine and toxicants), which should be taken fully into consideration,” the official added.

For Frederic de Wilde, president of the Philip Morris International tobacco company (PMI) in the European Union Region, the best choice that any smoker can make is to stop smoking, and many already have.

But smokers who don’t quit should not be left behind.

“Most smokers, however, continue using one of the most harmful ways to consume nicotine – cigarettes. In the EU alone, about 85 million people, or 19% of the population, still smoke,” de Wilde told EURACTIV.

The second-best choice, he said, is to switch to a non-combustible reduced-risk tobacco or nicotine product backed by scientific evidence.

“There is consensus that the primary cause of smoking-related diseases lies in approximately a hundred harmful compounds found in cigarette smoke, most generated by the burning, and that nicotine, while addictive and not risk-free, is not the primary cause of these diseases,” he noted,

On the other hand, he explained, non-combustible nicotine products such as pouches, snus, e-cigarettes, or heated tobacco are not risk-free but are a better alternative to cigarettes for those who do not quit.

“Our extensive scientific research on our heated tobacco product clearly indicates that it is a reduced-risk alternative to cigarettes,” he stressed.

De Wilde said similar conclusions were reached by bodies like the Superior Health Council in Belgium, the Risk Assessment Institute in Germany (BfR), the Health and Environment Institute in the Netherlands (RIVM), the Royal College of Physicians in the U.K., or the U.S. Food and Drug Administration (FDA).

“The Superior Health Council [in Belgium], despite reaching conclusions that are similar to ours as a result of their scientific review of our heated tobacco product, decided that the same regulatory framework as for cigarettes should apply to heated tobacco,” he said.

[Edited by Zoran Radosavljevic]

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